Provider Demographics
NPI:1104551076
Name:COVENEY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:COVENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1105
Mailing Address - Country:US
Mailing Address - Phone:636-938-3399
Mailing Address - Fax:
Practice Address - Street 1:20 THE LEGENDS PKWY
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3823
Practice Address - Country:US
Practice Address - Phone:636-938-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant